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Sick Pay Form Template for Indonesia

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Sick Pay Form

I need a sick pay form that allows employees to report their illness and request paid sick leave, including fields for personal details, dates of absence, and a section for medical certification if required. The form should comply with Indonesian labor laws and company policy regarding sick leave entitlements.

What is a Sick Pay Form?

A Sick Pay Form is an official document Indonesian employees use to claim their sick leave benefits and receive payment during illness-related absences. When you're too sick to work, this form helps track your medical leave and ensures you get paid according to Indonesia's labor laws, which guarantee sick pay for legitimate health-related time off.

The form typically requires your personal details, employment information, dates of absence, and a doctor's certificate confirming your condition. Under Indonesian Manpower Law No. 13/2003, employers must process these forms and provide sick pay, with the amount varying based on how long you're ill - from 100% salary for the first four months to reduced percentages for extended illnesses.

When should you use a Sick Pay Form?

Submit a Sick Pay Form immediately when illness prevents you from working in Indonesia. This applies when you need medical treatment, are hospitalized, or must recover at home. File the form within 24 hours of your first sick day, along with a doctor's note or medical certificate confirming your condition.

The form becomes essential for extended illnesses lasting more than three days, as Indonesian labor laws require detailed documentation for longer absences. Use it to claim your legally mandated sick pay benefits, which range from full salary coverage in the first four months to partial payments for longer periods. Filing promptly helps avoid payment delays and ensures proper tracking of your medical leave.

What are the different types of Sick Pay Form?

  • Standard Medical Leave Form: Basic version used for short-term illnesses under 14 days, requiring only a doctor's note and basic employee details
  • Extended Sick Leave Form: Comprehensive version for long-term illnesses, including detailed medical documentation and payment calculation sections
  • Hospital Admission Form: Specialized version for inpatient care, featuring sections for hospital details and estimated treatment duration
  • Work-Related Illness Form: Modified version linking illness to workplace conditions, often used with BPJS Ketenagakerjaan claims
  • Chronic Condition Form: Adapted for ongoing health issues, including treatment schedules and periodic review requirements

Who should typically use a Sick Pay Form?

  • Employees: Submit the Sick Pay Form when unable to work due to illness, along with required medical documentation and proof of treatment
  • HR Departments: Process forms, verify documentation, calculate sick pay entitlements, and maintain compliance with Indonesian labor laws
  • Medical Practitioners: Provide official diagnoses and medical certificates that validate the employee's condition and recovery timeline
  • BPJS Ketenagakerjaan: Reviews forms for work-related illnesses and processes related insurance claims
  • Company Management: Approves extended sick leave requests and ensures proper implementation of sick pay policies

How do you write a Sick Pay Form?

  • Personal Details: Gather employee information including name, ID number, position, and department
  • Medical Documentation: Obtain doctor's certificate stating diagnosis, treatment plan, and recommended leave duration
  • Leave Dates: Specify exact start and end dates of sick leave, including any hospital stays
  • Payment Information: Include employee's salary details and bank account for sick pay transfer
  • Supporting Evidence: Attach relevant medical receipts, prescriptions, or hospital discharge papers
  • Compliance Check: Verify form meets BPJS Ketenagakerjaan requirements and company sick leave policy guidelines

What should be included in a Sick Pay Form?

  • Employee Declaration: Formal statement confirming illness and inability to work
  • Medical Verification: Section for doctor's details, diagnosis, and official stamp or signature
  • Leave Duration: Clear specification of absence period with start and end dates
  • Payment Terms: Calculation method for sick pay according to Labor Law No. 13/2003
  • BPJS Information: Social security registration number and coverage details
  • Authorization Section: Spaces for employee, supervisor, and HR signatures with dates
  • Privacy Notice: Statement on medical data handling under Indonesian data protection laws

What's the difference between a Sick Pay Form and a Return to Work Form?

A Sick Pay Form differs significantly from a Return to Work Form in both timing and purpose, though they're often part of the same leave management process. While a Sick Pay Form initiates the medical leave and payment process, a Return to Work Form handles the employee's reintegration after recovery.

  • Documentation Timing: Sick Pay Forms are submitted at the start of illness, while Return to Work Forms are completed just before resuming duties
  • Required Information: Sick Pay Forms focus on medical diagnosis and payment calculations, whereas Return to Work Forms detail fitness-for-duty assessments and workplace accommodations
  • Legal Requirements: Sick Pay Forms fulfill BPJS Ketenagakerjaan payment regulations, while Return to Work Forms address workplace safety and liability concerns
  • Authorization Process: Sick Pay Forms require doctor and HR approval, but Return to Work Forms need occupational health clearance and department manager sign-off

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